Serum sterols in patients with primary biliary cirrhosis and acute liver failure before and after liver transplantation.
OBJECTIVE
Liver diseases modify sterol metabolism. Liver transplantation (LTX) provides a model to evaluate the impact of disease-affected liver on sterol metabolism.


METHODS
We studied serum sterol profiles and their relationships to other biochemical markers in consecutive cholestatic patients with acute liver failure (ALF, n=39) and end-stage primary biliary cirrhosis (PBC, n=67) before and 27d after LTX. Accordingly, we determined serum levels of sterols, bilirubin and prealbumin.


RESULTS
Due to weak cholesterol synthesis of ALF-patients before LTX, their serum levels of cholesterol, lathosterol/cholesterol, cholestanol/cholesterol and lathosterol/campesterol were 18%-41% lower (P<0.05 for each) than in PBC, but ratios of phytosterols to cholesterol were equal. In general, non-cholesterol sterol ratios reflected bilirubin and prealbumin concentrations. Interrelation of surrogate sterols showed that homeostasis of cholesterol metabolism prevailed in lowest cholestanol tertile of ALF-patients consistently, but not in PBC. After LTX, cholesterol levels and lathosterol ratios increased in both groups and phytosterol ratios decreased (P<0.01). Cholestanol decreased profoundly in PBC, but remained 26% higher than in ALF (P<0.05).


CONCLUSIONS
Homeostasis of cholesterol metabolism was maintained only in ALF. Metabolism of phytosterols was equal in study groups. PBC- and ALF-patients have differential patterns in their serum sterols and cholesterol metabolism.
Nikkilä
Katriina
K
Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland.
Nissinen
Markku J
MJ
Gylling
Helena
H
Isoniemi
Helena
H
Miettinen
Tatu A
TA
D000328:Adult; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002784:Cholesterol / Q000097:blood; D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000378:metabolism* / Q000601:surgery*; D017114:Liver Failure, Acute / Q000378:metabolism* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010840:Phytosterols / Q000097:blood; D011228:Prealbumin / Q000378:metabolism; D013261:Sterols / Q000097:blood*
D015415:Biomarkers; D010840:Phytosterols; D011228:Prealbumin; D013261:Sterols; C001521:lathosterol; D002784:Cholesterol; D001663:Bilirubin